The effect of maternal infections on birth outcomes at King Abdulaziz medical city: a retrospective cohort study

BACKGROUND: Maternal infections remain a contributor to preventable adverse pregnancy outcomes worldwide. In Saudi Arabia, comprehensive data on the prevalence and impact of maternal infections are still limited. This study aimed to evaluate the association of maternal infections with adverse birth outcomes. METHODS: A retrospective comparative cohort study was conducted among 10,761 pregnant women who delivered between 2019 and 2023. Women with clinically significant and medically treated maternal infections during pregnancy (n = 50) were compared to those without infections (n = 10,711). Outcomes assessed included preterm birth, low birth weight (LBW), Apgar scores, neonatal intensive care unit (NICU) admission, stillbirth, cesarean delivery, and length of hospital stay. RESULTS: Among the cohort, 50 women (0.46%) were diagnosed with maternal infections. Compared to non-infected women, those with maternal infections had significantly higher odds of preterm birth (34% vs. 10.70%; AOR 3.40, 95% CI 1.95–5.90), LBW (40% vs. 11.26%; AOR 3.64, 95% CI 2.01–6.58), low Apgar scores at 5 min (4% vs. 0.30%; AOR 4.62, 95% CI 2.20–9.70), NICU admission (10% vs. 5.56%; AOR 1.89, 95% CI 1.03–3.48, p = 0.041), and stillbirth (4% vs. 0.36%; AOR 8.10, 95% CI 1.65–39.90). Differences in cesarean delivery (52% vs. 40%; p = 0.093) and prolonged hospitalization were not statistically significant. CONCLUSION: Although maternal infections affected fewer than 1% of pregnancies in this cohort, they showed significant associations with adverse neonatal outcomes, including preterm birth, LBW, NICU admission, and stillbirth. These findings underscore the need for enhanced antenatal screening, timely diagnosis, and targeted management.